Income generating activities of people who inject drugs
Introduction
Traditionally, society has attempted to discourage psychoactive drug use by employing a range of law enforcement tactics. These approaches have been shown to inflate the price of illegal drugs. The high costs associated with illegal substances may deter and regulate drug use among certain individuals (Benson et al., 2001); however, other drug users may resort to various forms of prohibited activities, including drug dealing, sex trade work and acquisitive crime to generate sufficient income to support their preferred level of drug consumption (Casavant and Collin, 2001, Benson et al., 1992, Brochu et al., 1999, Haynes, 1998, Nurco, 1987).
Past investigations have established a strong link between drug dependency and prohibited income generating activities (Stevens et al., 2003, Sherman and Latkin, 2002, Fischer et al., 2001, Deschenes and Anglin, 1991, Silverman and Spruill, 1977). High levels of prohibited activity have also been found to coincide with periods of heavy drug consumption (Grapendaal et al., 1995, Nurco et al., 1985, Ball et al., 1983). Additionally a lack of employable job skills, past criminal histories and high profits derived from drug dealing have been identified as factors influencing substance dependent individuals to engage in prohibited income generating behavior (Sherman et al., 2006, Rothbard et al., 1999, Bretteville-Jensen and Sutton, 1996, Hammersley et al., 1989).
Prohibited income generating activities have a number of potential negative impacts on individuals and society. In 2002 the Canadian Centre on Substance Abuse found that in Canada over 20% of federal inmates report that they committed their most serious offence in order to obtain illegal drugs (Pernanen et al., 2002). The costs of incarcerating substance addicted individuals for their criminal income generating acts is only one aspect of the negative social impacts of this phenomenon. Theft, fraud and other types of acquisitive crime financially burden society and activities that surround drug dealing have been associated with public nuisances and increased drug consumption by making illegal substances readily available (Bretteville-Jensen and Sutton, 1996). Additionally, confrontations related to the illegal drug market account for the majority of violent interactions involving drug users (Casavant and Collin, 2001, Erickson, 2001, Caulkins and Reuter, 1996), making drug dealing a dangerous activity.
Involvement in the sex trade industry is also associated with significant health risks and social costs. In Canada the sale of sexual services between consenting adults is legal; however, provisions regarding bawdy houses, procuring and communicating make many of the acts surrounding sex trade work illegal. In turn sex trade workers operate in an inherently dangerous unsanctioned environment, which threatens their health and safety (Goodyear et al., 2005, Blankenship and Koester, 2002).
The relationship between negative health outcomes and activities such as panhandling and salvaging recyclable materials (binning) may appear less direct. However, major urban cities, including the City of Vancouver, Canada, have identified such activities as potential economic threats to urban cores as some citizens report feeling unsafe around individuals engaging in these activities and therefore may avoid affected areas. Similarly, there are concerns that a high prevalence of panhandling and binning threatens the public image of affected cities and thereby has the potential to deter tourism and foreign investment (City of Vancouver, 2006). In a number of major cities in North America (e.g., Toronto, Atlanta, Baltimore, Cincinnati, New Haven, New York City, Philadelphia, Portland, San Francisco, and Seattle) policy makers have introduced legislation to increase the ability of law enforcement to arrest and prosecute individuals for panhandling and engaging in other undesirable behavior (New York State Law, 2006, Safe Streets Act, 1999).
While previous studies have identified prohibited income generation among injection drug users (IDU) (Sherman and Latkin, 2002), there have been few studies that have assessed the characteristics of IDU who engage in such activities. As well, there have been few studies that have detailed the amount of income derived from various prohibited sources and examined the role of ongoing drug use in perpetuating engagement in different prohibited income generating activities. Therefore, we sought to explore the prevalence of and factors associated with engaging in prohibited income generating activities among a community-recruited cohort of IDU. We also sought to shed light on the relationship between the costs associated with purchasing illegal substances and motivations for engaging in prohibited income generating activity among IDU.
Section snippets
Methods
Beginning in May 1996, persons who had injected illegal drugs in the previous month were recruited into the Vancouver Injection Drug User Study (VIDUS), a prospective cohort study that has been described in detail previously (Tyndall et al., 2002, Wood et al., 2001). Briefly, persons were eligible for the VIDUS study if they had injected illegal drugs at least once in the previous month, resided in the greater Vancouver region, and provided written informed consent. At baseline and
Results
During the study period, 465 individuals completed follow-up visits and 275 (59%) reported active injection drug use. Of the 275 active injecting participants eligible for this analysis 127 (46%) were women and the median age of participants was 39 (IQR = 30–47). As indicated in Table 1, a total of 145 (53%) study participants reported having generated income through prohibited activities in the last 30 days, while 118 (43%) reported engaging in at least one of the restricted set of riskier
Discussion
In the present study, we found that 53% of our active IDU sample reported generating income through prohibited activities, with drug dealing and sex trade work found to be the most prevalent sources of income. Factors independently associated with engaging in prohibited income generating activities were frequent crack use and frequent heroin injection. Non-aboriginal females were the group most strongly associated with prohibited income generation; however, it is important to note that
Funding sources
Funding for this study was provided by the US National Institutes of Health (R01 DA011591-04A1) and the Canadian Institutes of Health Research (MOP-67262). Thomas Kerr is supported by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research. Kate Shannon is supported by a Michael Smith Foundation for Health Research Senior Graduate Studentship and a Canadian Institutes of Health Research Doctoral Research Award. NIH, CIHR and MSFHR had no further role in
Authors’ contributions
KD, TK and KS designed the study and wrote the protocol. Author KD managed the literature search and summaries of previous related work. Author KL undertook the statistical analysis and authors KD and TK wrote the first draft of the manuscript. KS, EW and JM contributed to the main content and provided critical comments on the final draft. All authors contributed to and have approved the final manuscript.
Conflict of interest
Dr. Julio Montaner has received grants from, served as an ad hoc adviser to, or spoken at various events sponsored by: Abbott, Argos Therapeutics, Bioject Inc., Boehringer Ingelheim, BMS, Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Janssen-Ortho, Merck Frosst, Pfizer, Schering, Serono Inc., TheraTechnologies, Tibotec, Trimeris. All other authors declare that they have no conflicts of interest.
Acknowledgements
We would particularly like to thank the VIDUS participants for their willingness to participate in the study. We also thank Drs. Steffanie Strathdee, Richard Harrigan, David Patrick, and Mark Tyndall, as well as Bonnie Devlin, John Charette, Caitlin Johnston, Vanessa Volkommer, Steve Kain, Sidney Crosby, Cristy Power, Cody Callon, Nancy Laliberte, Sue Currie, Deborah Graham, Carley Taylor, and Peter Vann for their research and administrative assistance.
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